医院产权制度改革若干理论问题的思考

当前，医院产权制度改革实践中的一些领域仍然需要理论支持，从理论角度对产权明晰、医院治理、产权经营、效果评价方面做了分析，指出了当前存在的一些误区，并就某些问题提出了建议。     

高忠英治疗月经病用药特色与规律

高忠英教授是国家名老中医药专家,在妇科月经病的调治中,灵活运用经方,依据女子的生理病理特点,研究方药的运用规律,经过日积月累反复实践,形成了自己独特的辨证思维与用药特色,临证治疗中,常获显著疗效。研究收集了高教授近5年治疗月经病的病历,应用计算机数字系统进行总结分析,先用EXCEL软件分类录入原始数据,然后通过SPSS分析系统进行处理,分别统计所用药物的数量、分类、药性、归经,并依次计算出其使用频数构成比。在此基础上运用中医理论总结归纳得出结论:高忠英教授在治疗月经病的用药规律上具有6个方面的显著特色。     

The estimation of moments: A technical note

The calculation of several common pharmacokinetic parameters requires estimates of both the area under the curve of the concentration of the drug in a sampled fluid vs. time, and also the first moment about t=0 of this area. It is proposed that the methods used to estimate these quantities should make consistent assumptions about the concentration of the drug. There appears to be an inconsistency in the standard published formulas in the case where concentration is interpolated linearly. A more consistent formula is derived.     

芍药甘草汤配伍意义的药动学研究

目的：通过检测给予芍药、甘草单方或合剂芍药甘草汤后，动物血浆中芍药苷、甘草次酸的药动学参数，探索芍药甘草汤配伍的合理性。方法：将芍药、甘草及芍药甘草汤制成水煎液，分别灌胃给予SD大鼠，采用HPLC/MS/MS法测定大鼠血浆中芍药苷、甘草次酸的血药浓度，并计算主要药动学参数。结果：与单方相比，给予芍药甘草汤后大鼠血浆中甘草次酸的达峰时间提前，峰浓度增加；芍药苷达峰浓度提高、相对生物利用度增加；两成分均出现半衰期缩短现象。结论：臣药甘草促进了君药芍药中芍药苷的吸收，提高了它的体内浓度与含量，这可能是复方芍药甘草汤解痉、镇痛、镇静等功效强劲有力的体内药动学依据。君药芍药提前助燃了臣药甘草中甘草次酸在体内出现的时间和数量，这也可能是复方芍药甘草汤抗溃疡、解痉、抗炎等功效迅速高效的体内药动学依据。本实验从药动学角度证明了芍药甘草汤配伍的合理性。     

He-Ne激光照射后细菌生长规律的理论与实验分析

目的：探寻Ｈｅ－Ｎｅ激光照射后细菌的生长规律。方法：通过对实验结果进行分析，建立Ｈｅ－Ｎｅ激光照射后细菌生长所符合的微分方程，并解方程。结果：建立了Ｈｅ－Ｎｅ激光照射后细菌生长规律的理论并由此得出生长规律的理论公式。用此公式拟合有关实验数据，结果符合得很好。结论：此理论有助于揭示Ｈｅ－Ｎｅ激光作用于机体的完整机制；还有利于食品发酵工业的生产，提高生产效率。     

Triage Nurse Application of the Ottawa Knee Rule

OBJECTIVE: To determine interobserver agreement between triage registered nurses (RNs) and emergency physicians (EPs) regarding indication for knee radiographs by applying the Ottawa knee rule (OKR) and individual components of the rule. METHODS: This was a prospective, observational study in a suburban, teaching emergency department. The study enrolled a convenience sample of patients aged >17 years with traumatic knee injuries less than one week old. Patients with prior knee surgery or distracting conditions were excluded. Before study initiation, the RNs and EPs were in-serviced in the OKR. Nurses and EPs independently examined each patient for OKR criteria, blinded to the other's assessment. Knee radiographs were ordered at the discretion of the EP and were interpreted by board-certified radiologists. All patients received follow-up with a structured telephone interview to identify any undetected fractures. Kappa was calculated for each component and the overall application of the OKR to assess interobserver agreement. RESULTS: Ninety-six patients were enrolled. The mean age was 39.6 +/- 18.7 years; 50% were male. Eight patients (8%) had knee fractures. Interobserver agreements between the RNs and EPs for individual components of the OKR were: age > or =55 years (kappa = 0.97); inability to weight bear (kappa = 0.51); inability to bend knee to 90 degrees (kappa = 0.52); fibular head tenderness (kappa = 0.45); and isolated patellar tenderness (kappa = 0.40). The EPs and RNs agreed with OKR criteria for x-ray 71% of the time (kappa = 0.41). CONCLUSIONS: The only criterion that resulted in almost perfect agreement between the RNs and EPs was patient age; agreement for the other four criteria and the overall decision to order x-rays was moderate.     

黄芩自生酶催化水解总黄酮苷的工艺研究

目的研究黄芩自生酶催化水解总黄酮苷的工艺条件。方法采用正交试验，考察了加水量、温度和时间等因素，采用HPLC法测定了药材中黄芩苷、黄芩素、汉黄芩素、千层纸素-A的含量。结果确定最优酶催化水解工艺条件为取药材，加4倍量水，于32℃酶催化水解12h，烘干后备用。结论黄芩自生酶催化水解总黄酮苷是一种环保、经济、可行的方法。     

Interrater Reliability of Criteria Used in Assessing Blunt Head Injury Patients for Intracranial Injuries

OBJECTIVE: To determine the interrater reliability of potential predictor variables that may be used to construct a clinical decision rule for emergency computed tomography of the head in blunt head injury victims. METHODS: As a substudy of the NEXUS II study of blunt head trauma, physicians from 21 different emergency departments performed paired evaluations of patients undergoing computed tomography of the head after blunt head injury. Each physician independently determined, for each subject, the presence or absence of each of 19 separate clinical characteristics. The physicians were either residents or attending physicians in the participating emergency departments. Paired responses on a sample of 3,951 patients were compared for raw level of agreement and for interrater concordance using the kappa statistic. If the lower margin of the 95% confidence interval for raw agreement was at least 85% and was equal to or greater than 0.50 for kappa, this was predetermined to represent substantial interrater agreement. RESULTS: There was substantial interobserver agreement by both measures for 17 of the 19 candidate variables in patients with blunt head trauma. Interobserver agreement was substantial for all candidate variables except presence of seizure (kappa = 0.57 [95% CI = 0.47 to 0.67]; raw agreement = 96.5%) and abnormal cerebellar function (kappa = 0.54 [95% CI = 0.41 to 0.67]; raw agreement = 96.5%). CONCLUSIONS: The clinicians in our study had a substantial level of agreement regarding most clinical criteria assessed in this large sample of patients with blunt head injury.     

Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?

Objectives

The ‘10% rule’ has become widely accepted by surgeons performing sentinel lymph node biopsy (SLNB) for melanoma. The purpose of this study was to compare the ‘10% rule’ with alternative node harvesting criteria. In particular, we were interested to see whether the use of blue dye had any impact on the sensitivity of the test and whether it is necessary to remove all hot nodes.